CR Group Research Articles

Chimney reconstruction provides a wider subaortic space and reduces the risk of pulmonary artery compression in the Norwood-type aortic arch reconstruction without patch supplementation.

Pulmonary artery (PA) compression by the neoaorta is a serious complication after the Norwood-type palliation (NP) for hypoplastic left heart syndrome. Either excess patch tailoring or limited use of autologous tissue may cause narrowing of the subaortic space. The chimney technique could theoretically provide a wide subaortic space. Twenty-nine patients with both pre- and post-NP computed tomography data available of the 37 consecutive patients who underwent NP in our institution were reviewed. Arch height, arch width, sinus of Valsalva diameter, area under the neoaortic arch and arch angle were measured. These patients were divided according to the neo-arch reconstruction technique, chimney reconstruction technique (CR) or conventional direct reconstruction technique (DR). Median age and weight at NP were 2.1 months and 3.5 kg, respectively. Twenty-two patients underwent previous bilateral PA banding. During NP, 17 CR and 12 DR were performed. Four patients in the DR group developed PA compression. No neoaortic arch dilatation was found in either group. Post-NP arch width, area under the neo-arch and the arch angle were significantly larger in the CR group. Pre-NP arch height was significantly smaller in DR patients with PA compression than in those without. The chimney technique decreased the risk of PA compression and provided a wider subaortic space and a less acute arch angle. This technique had no short-term effect on the neoaortic root. Small preoperative arch height is a potential risk factor for PA compression in DR, and the chimney technique could be an effective solution.

Effect of finishing diet on carcass characteristics and meat quality of Mos cockerel

Aim of study: To evaluate the effect of different diets on carcass characteristics and meat quality from Mos free-ranged cockerel.Area of study: Galicia (NW Spain).Material and methods: Cockerels (n=75) were allocated to 3 groups (n=25) according to finishing diets: commercial fodder (CF), 50% wheat and 50% corn (WH) and 33% wheat and 66% corn (CR). Meat quality was assessed in terms of physicochemical, and nutritional features.Main results: The highest live and carcass weight were obtained in CF group. Meat from CF and CR groups were similar in moisture, protein and cholesterol content in drumstick cut, meanwhile in breast piece there were no significant differences (p>0.05) in intramuscular fat (IMF), ash, and lightness (L*). On the other hand, finishing diet affected L* and redness (a*) values, showing the highest L* values in meat samples from CF treatment (49.94 for drumstick) (p<0.01), whereas a* was superior in WH samples (11.30 and 4.61, for drumstick and breast, respectively) (p<0.001). Meat shear force test was not affected (p>0.05) by diets. Finally, the finishing feed affected (p<0.05) the fatty acid and amino acid profile in both cuts (drumstick and breast).Research highlights: Present study allowed to characterize for the first time Mos cockerels fed with different diets. Some carcass features obtained were higher than previous studies with other Mos categories, and some autochthonous and industrial breeds. Meat from cockerels was characterized by a high protein percentage and lower IMF.

POS-057 IMPACT OF SEVERITY AND AETIOLOGY OF ACUTE KIDNEY INJURY ON RENAL PROGNOSIS IN TWO REFERRAL HOSPITALS IN CAMEROON

Acute kidney injury (AKI) is associated with a high morbi-mortality worldwide and an increase in health costs. It increases the risk of developing chronic kidney disease (CKD). Various factors associated with poor renal prognosis have been described. These include advanced age, severity, duration and frequency of AKI, the existence of an underlying CKD or oliguria. To our knowledge, there are still several limitations to the current studies, such as studies provided by single institutions and more often on Caucasian population. Furthermore, no study has been carried out in our setting to assess the impact of the severity of AKI and its aetiology on renal prognosis. The aim was to evaluate the impact of severity and aetiology of AKI on renal prognosis in two referral hospitals in Cameroon. We conducted a retrospective cohort study for a period from January 1, 2015 to April 30, 2017. Patients older than 18 years with AKI admitted and followed-up for at least 3 months at the nephrology unit of either the Yaounde General Hospital or the Yaounde University Teaching Hospital during the study period were included. Incomplete records, AKI of non-organic mechanism were excluded. Sociodemographic and clinical data were collected on technical data sheets from patient’s records and medical registries. Staging of AKI was assessed by using the 2012 KDIGO classification. Data analysis was done using SPSS software version 20. The significance threshold was set at p <0.05. The study was approved by the Faculty of Medicine and Biomedical Sciences ethics committee. We included a total of 83 patients (36 with non-complete recovery of the renal function and 47 with complete recovery) with an average age of 46.6 ± 13.8 years and 60.2% of males. Patients with non-complete recovery of the renal function (non CR group) were similar to those with complete recovery (CR group) in terms of age (p=0.25) and sex (p=0.051). The reference period was greater than 72 hours in 88.9% and 29.8% respectively of the patients of the non CR group and the CR group (p<0.001). The other clinical features were similar for both groups. Stage 3 of AKI increased the risk of lack of complete recovery of renal function by 56-fold (OR: 56.1, 95% CI = 5.6-561.5 and p=0.001). Malignant hypertension was associated with a 22-fold risk of non-recovery of renal function (OR: 22.5, 95% CI = 2.5-204.4, p = 0.006). The severity and aetiology of AKI influence the renal prognosis. Stage 3 of AKI and malignant hypertension are associated with an increased risk of lack of complete recovery of renal function within 3 months after AKI.

Dynamic Response of Donor-Derived Cell-Free DNA Following Treatment of Acute Rejection in Kidney Allografts.

The quantification of rejection treatment efficacy has been insufficient using traditional markers due, in part, to the lagging response of serum creatinine and histologic alterations on biopsy specimens. Donor-derived cell-free DNA (dd-cfDNA) is a molecular marker of injury that may assess allograft injury after rejection. Retrospective review of the DART study identified 70 patients who had a clinically indicated biopsy, simultaneous dd-cfDNA measurement, and at least one follow-up dd-cfDNA within 3 months post-treatment. Thirty-five patients had no biopsy-proven rejection and no rejection treatment (NR), 16 patients had no biopsy-proven rejection but did receive rejection treatment (CR), 9 patients had diagnosis of ABMR/mixed rejection on biopsy and received rejection treatment (ABMR), and 10 patients had diagnosis of TCMR and received rejection treatment (TCMR). The CR, ABMR, and TCMR groups combined to form a rejection (R) group. In the R group, median dd-cfDNA values at baseline and 1 month were 0.62% and 0.35% (n=21 pairs, p=0.34), and at baseline and 2-3 months were 0.77% and 0.21% (n=23 pairs, p=0.002). In TCMR, median dd-cfDNA values at baseline and 1 month were 1.13% and 0.37% (n=5 pairs, p=0.63), and at baseline and 2-3 months were 0.25% and 0.12% (n=9 pairs, p=0.004). In ABMR, median dd-cfDNA values at baseline and 1 month were 1.61% and 1.2 % (n=6 pairs, p>0.99), and at baseline and 2-3 months were 3.85% and 1.32% (n=6 pairs, p=0.09). In CR, median dd-cfDNA values at baseline and 1 month were 0.31% and 0.29% (n=10 pairs, p=0.38), and at baseline and 2-3 months were 0.38% and 0.17% (n=8 pairs, p=0.31). Lastly, in NR, median dd-cfDNA values at baseline and 1 month were 0.23% and 0.18% (n=21 pairs, p=0.10), and at baseline and 2-3 months were 0.33% and 0.17% (n=26 pairs, p=0.003). Changes in serum creatinine across 1 month and 2-3 months following rejection were similar. dd-cfDNA may be a useful dynamic biomarker to assess the health of the kidney allograft following rejection treatment.

Prognostic effects of cardiovascular rehabilitation: facts and myths.

Since CR was introduced, studies have been carried out to discover the effect of CRHPs on cardiovascular morbidity and mortality and on heart-disease patients' quality of life. The first meta-analyses showed improvement in cardiovascular morbidity and mortality, although the studies were conducted in the coronary pre-reperfusion era, before the generalized use in secondary prevention of drugs such as statins, beta-blockers, or renin-angiotensin-system inhibitors, which have produced a decrease in cardiovascular mortality. In Europe, analyzing 25 studies with more than 200,000 patients. It concluded that, in spite of the great heterogeneity of the programs, CR clearly decreases mortality after ACS. Nevertheless, a strategy of CRHP standardization and evaluation is needed. In 2017, a study was carried out in our hospital to evaluate the effectiveness of multidisciplinary CRHP intervention on cardiovascular morbidity and mortality, recurrence of cardiovascular events, the control of RFCV and lifestyle changes in patients after ACS. A total of 442 patients were included who had presented an acute cardiovascular event in the previous six months; 306 patients from the CR group and 136 others with standard cardiology follow-up were used as controls. 405 patients completed follow-up for a median of 60 months. Compared to the usual treatments in cardiology, the patients who underwent CRHPs presented fewer readmissions for cardiovascular reasons (17% vs. 43.38%, P<0.001), fewer major cardiovascular events (11.9% vs. 27.2%, P<0.001) and new revascularizations (9.3% vs. 21.32%, P=0.001), with lower cardiovascular mortality (0 vs. 2.2%, P=0.014). It also led to better control of the RFCV (66% vs. 19.85%, P<0.001) and favored lifestyle changes in these patients (91% vs. 61%, P<0.001). Therefore, in our setting, the performance of CRHPs was shown to be effective in reducing cardiovascular morbidity and mortality and in the secondary prevention of coronary patients.

CardioMEMS Pulmonary Artery Pressure Guided Management of Advanced HF Patients Supported with a HeartMate LVAD: INTELLECT 2-HF Study

PurposeHemodynamic-guided management with a pulmonary artery pressure (PAP) sensor (CardioMEMS) is effective in reducing HF hospitalization (HFH) in chronic HF patients. We sought to determine the utility of managing patients on continuous-flow LVAD support using the CardioMEMSTM HF system.MethodsIn this multi-center observational study, we enrolled patients with a HeartMate 2 (HM2) (n=52) or HM3 (n=49) LVAD who either already had a CardioMEMS sensor (n=53) or were clinically implanted after enrollment for residual HF (n=48). Patients underwent assessments at baseline, 1, 3 and 6 months for endpoints: 6-minute walk distance (6MWD), change in PAP, quality of life score (EQ-5D-5L scores), and HFH rates. Patients were stratified post-hoc as clinical responders (cR) if there was a reduction in PA diastolic pressure (PAD) of at least 1 mmHg at 6 months, and the remainder were deemed non-responders (cNR).ResultsOf 101 patients enrolled, 88 patients completed 6-month follow-up. PAP measurement was feasible with excellent weekly patient compliance (91.1% ± 19.8%). There were no clinically relevant differences between cR (n=37) and cNR (n=46) patients at baseline (data not shown). PAD at 6 months was 3.5 ± 4.6 mmHg lower than baseline within the cR group (20.8 to 17.3 mmHg, p=0.0002) (Figure-panel A). While there were no observed differences in QoL or HFH between cR and cNR, significant increases in 6MWD occurred among cR (286 vs 332 meters, p=0.03, Figure-panel B). Those individuals who maintained a PAD < 20mmHg had significantly reduced HFH (Figure-panel C).ConclusionThe use of CardioMEMS system in HeartMate LVAD patients is feasible. Significant reduction in PAD at 6 months was associated with improvements in 6MWD and achieving a PAD < 20 mmHg was associated with lower HFH events. These findings provide justification and guidance for prospective investigations utilizing the CardioMEMS system to improve the management and outcomes of LVAD patients. Hemodynamic-guided management with a pulmonary artery pressure (PAP) sensor (CardioMEMS) is effective in reducing HF hospitalization (HFH) in chronic HF patients. We sought to determine the utility of managing patients on continuous-flow LVAD support using the CardioMEMSTM HF system. In this multi-center observational study, we enrolled patients with a HeartMate 2 (HM2) (n=52) or HM3 (n=49) LVAD who either already had a CardioMEMS sensor (n=53) or were clinically implanted after enrollment for residual HF (n=48). Patients underwent assessments at baseline, 1, 3 and 6 months for endpoints: 6-minute walk distance (6MWD), change in PAP, quality of life score (EQ-5D-5L scores), and HFH rates. Patients were stratified post-hoc as clinical responders (cR) if there was a reduction in PA diastolic pressure (PAD) of at least 1 mmHg at 6 months, and the remainder were deemed non-responders (cNR). Of 101 patients enrolled, 88 patients completed 6-month follow-up. PAP measurement was feasible with excellent weekly patient compliance (91.1% ± 19.8%). There were no clinically relevant differences between cR (n=37) and cNR (n=46) patients at baseline (data not shown). PAD at 6 months was 3.5 ± 4.6 mmHg lower than baseline within the cR group (20.8 to 17.3 mmHg, p=0.0002) (Figure-panel A). While there were no observed differences in QoL or HFH between cR and cNR, significant increases in 6MWD occurred among cR (286 vs 332 meters, p=0.03, Figure-panel B). Those individuals who maintained a PAD < 20mmHg had significantly reduced HFH (Figure-panel C). The use of CardioMEMS system in HeartMate LVAD patients is feasible. Significant reduction in PAD at 6 months was associated with improvements in 6MWD and achieving a PAD < 20 mmHg was associated with lower HFH events. These findings provide justification and guidance for prospective investigations utilizing the CardioMEMS system to improve the management and outcomes of LVAD patients.

The effect of calorie intake, fasting, and dietary composition on metabolic health and gut microbiota in mice

BackgroundCalorie restriction (CR) and intermittent fasting (IF) can promote metabolic health through a process that is partially mediated by gut microbiota modulation. To compare the effects of CR and IF with different dietary structures on metabolic health and the gut microbiota, we performed an experiment in which mice were subjected to a CR or IF regimen and an additional IF control (IFCtrl) group whose total energy intake was not different from that of the CR group was included. Each regimen was included for normal chow and high-fat diet.ResultsWe showed that in normal-chow mice, the IFCtrl regimen had similar positive effects on glucose and lipid metabolism as the CR regimen, but the IF regimen showed almost no influence compared to the outcomes observed in the ad libitum group. IF also resulted in improvements, but the effects were less marked than those associate with CR and IFCtrl when the mice were fed a high-fat diet. Moreover, CR created a stable and unique gut microbial community, while the gut microbiota shaped by IF exhibited dynamic changes in fasting-refeeding cycles. At the end of each cycle, the gut microbiota of the IFCtrl mice was similar to that of the CR mice, and the gut microbiota of the IF mice was similar to that of the ad libitum group. When the abundance of Lactobacillus murinus OTU2 was high, the corresponding metabolic phenotype was improved regardless of eating pattern and dietary structure, which might be one of the key bacterial groups in the gut microbiota that is positively correlated with metabolic amelioration.ConclusionThere are interactions among the amount of food intake, the diet structure, and the fasting time on metabolic health. The structure and composition of gut microbiota modified by dietary regimens might contribute to the beneficial effects on the host metabolism.

Correlation between alterations in blood flow of malignant lymphomas after induction chemotherapies and clinical outcomes: a pilot study utilising contrast-enhanced ultrasonography for early interim evaluation of lymphoma treatment

To clarify the utility of contrast-enhanced ultrasonography (CEUS) for interim evaluation of response to chemotherapy in lymphoma treatment. CEUS was performed both before (day 0) and after the treatment (7 and/or 14 days), and a time-intensity curve was obtained. The patients were divided into two groups (complete remission [CR] group and non-CR group) according to the results of conventional response evaluation, and peak enhancement (PE), time to peak enhancement, perfusion index (PI), the total area under the curve during wash-in (AUC-in), and the total AUC were compared between the groups. Among 27 patients with various types of lymphoma, the median change ratio of PE and PI at day 7 evaluation were significantly different between the CR group and the non-CR group (0.81 versus 1.39, p=0.017 for PE and 0.92 versus 2.09, p=0.010 for PI). The change ratio of PE<1.09 (specificity: 86%; sensitivity, 88%) and PI<1.65 (specificity: 86%; sensitivity: 94%) distinguished CR from non-CR. Patients who achieved a PE change ratio <1.09 or a PI change ratio <1.65 had significantly better estimated progression-free survival (p<0.001). The present study demonstrated that changes in tumour perfusion parameters evaluated with CEUS at 1 week after the treatment initiation were significantly different between lymphoma patients in CR group and non-CR group. Alterations in perfusion parameters evaluated via CEUS could impact the prognosis of lymphoma patients.

Implant design affects walking and stair navigation after total knee arthroplasty: a double-blinded randomised controlled trial

BackgroundDissimilar total knee arthroplasty implant designs offer different functional characteristics. This is the first work in the literature to fully assess the Columbus ultra-congruent mobile (UCR) system with a rotating platform.MethodsThis is a double-blinded randomised controlled trial, comparing the functional performance of the low congruent fixed (CR DD), ultra-congruent fixed (UC) and UCR Columbus Total Knee Systems. The pre-operative and post-operative functional performance of twenty-four osteoarthritic patients was evaluated against nine control participants when carrying out everyday tasks. Spatiotemporal, kinematic and kinetic gait parameters in walking and stair navigation were extracted by means of motion capture.ResultsThe UC implant provided better post-operative function, closely followed by the UCR design. However, both the UC and UCR groups exhibited restricted post-operative sagittal RoM (walking, 52.1 ± 4.4° and 53.2 ± 6.6°, respectively), whilst patients receiving a UCR implant did not show an improvement in their tibiofemoral axial rotation despite the bearing’s mobile design (walking, CR DD 13.2 ± 4.6°, UC 15.3 ± 6.7°, UCR 13.5 ± 5.4°). Patients with a CR DD fixed bearing showed a statistically significant post-operative improvement in their sagittal RoM when walking (56.8 ± 4.6°).ConclusionIt was concluded that both ultra-congruent designs in this study, the UC and UCR bearings, showed comparable functional performance and improvement after TKA surgery. The CR DD group showed the most prominent improvement in the sagittal RoM during walking.Trial registrationThe study is registered under the clinical trial registration number: NCT02422251. Registered on April 21, 2015.

Chromium isotopic insights into the origin of chondrite parent bodies and the early terrestrial volatile depletion

Chondrites are meteorites from undifferentiated parent bodies that provide fundamental information about early Solar System evolution and planet formation. The element Cr is highly suitable for deciphering both the timing of formation and the origin of planetary building blocks because it records both radiogenic contributions from 53Mn-53Cr decay and variable nucleosynthetic contributions from the stable 54Cr nuclide. Here, we report high-precision measurements of the mass-independent Cr isotope compositions (ε53Cr and ε54Cr) of chondrites (including all carbonaceous chondrites groups) and terrestrial samples using for the first time a multi-collection inductively-coupled-plasma mass-spectrometer to better understand the formation histories and genetic relationships between chondrite parent bodies. With our comprehensive dataset, the order of decreasing ε54Cr (per ten thousand deviation of the 54Cr/52Cr ratio relative to a terrestrial standard) values amongst the carbonaceous chondrites is updated to CI = CH ≥ CB ≥ CR ≥ CM ≈ CV ≈ CO ≥ CK > EC > OC. Chondrites from CO, CV, CR, CM and CB groups show intra-group ε54Cr heterogeneities that may result from sample heterogeneity and/or heterogeneous accretion of their parent bodies. Resolvable ε54Cr (with 2SE uncertainty) differences between CV and CK chondrites rule out an origin from a common parent body or reservoir as has previously been suggested. The CM and CO chondrites share common ε54Cr characteristics, which suggests their parent bodies may have accreted their components in similar proportions. The CB and CH chondrites have low-Mn/Cr ratios and similar ε53Cr values to the CI chondrites, invalidating them as anchors for a bulk 53Mn-53Cr isochron for carbonaceous chondrites. Bulk Earth has a ε53Cr value that is lower than the average of chondrites, including enstatite chondrites. This depletion may constrain the timing of volatile loss from the Earth or its precursors to be within the first million years of Solar System formation and is incompatible with Earth’s accretion via any of the known chondrite groups as main contributors, including enstatite chondrites.

Pre-treatment PET/MRI based FDG and DWI imaging parameters for predicting HPV status and tumor response to chemoradiotherapy in primary oropharyngeal squamous cell carcinoma (OPSCC)

ObjectivesTo determine the feasibility of pre-treatment primary tumor FDG-PET and DWI-MR imaging parameters in predicting HPV status and the second aim was to assess the feasibility of those imaging parameters to predict response to therapy. Material and MethodsWe retrospectively analyzed primary tumors in 33 patients with proven OPSCC. PET/MRI was performed before and 6 months after chemo-radiotherapy for assessing treatment response. PET Standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and apparent diffusion coefficient (ADC) from pre-treatment measurements were assessed and compared to the clinicopathological characteristics (T stages, N stages, tumor grades, HPV and post-treatment follow up). HPV was correlated to the clinicopathological characteristics. ResultsADCmean was significantly lower in patients with HPV+ve than HPV-ev, (P = 0.001), cut off value of (800 ± 0.44*10-3mm2/s) with 76.9% sensitivity, and 72.2% specificity is able to differentiate between the two groups. No significant differences were found between FDG parameters (SUVmax, TLG, and MTV), and HPV status, (P = 0.873, P = 0.958, and P = 0.817), respectively. Comparison between CR and NCR groups; ADCmean, TLG, and MTV were predictive parameters of treatment response, (P = 0.017, P = 0.013, and P = 0.014), respectively. HPV+ve group shows a higher probability of lymph nodes involvement, (P = 0.006) ConclusionOur study found that pretreatment ADC of the primary tumor can predict HPV status and treatment response. On the other hand, metabolic PET parameters (TLG, and MTV) were able to predict primary tumor response to therapy.

F-Block Phospholyl and Arsolyl Chemistry.

The f‐block chemistry of phospholyl and arsolyl ligands, heavier p‐block analogues of substituted cyclopentadienyls (CpR, C5R5) where one or more CR groups are replaced by P or As atoms, is less developed than for lighter isoelectronic C5R5 rings. Heterocyclopentadienyl complexes can exhibit properties that complement and contrast with CpR chemistry. Given that there has been renewed interest in phospholyl and arsolyl f‐block chemistry in the last two decades, coinciding with a renaissance in f‐block solution chemistry, a review of this field is timely. Here, the syntheses of all structurally characterised examples of lanthanide and actinide phospholyl and arsolyl complexes to date are covered, including benzannulated derivatives, and together with group 3 complexes for completeness. The physicochemical properties of these complexes are reviewed, with the intention of motivating further research in this field.

Anatomic Repair vs Closed Reduction of the Syndesmosis.

Background:The goal of the study was to compare radiographic and functional outcomes between conventional closed syndesmotic reduction and screw fixation with open reduction, direct repair of the anterior inferior tibiofibular ligament (AiTFL) and screw fixation. We hypothesized that open reduction with restoration of the AiTFL would provide an improved reduction with better radiographic and functional outcomes.Methods:Fifty consecutive patients with OTA 44-C ankle fractures were enrolled. Treatment was nonrandomized and based on surgeon preference. Patients were treated with either open reduction, suture-anchor AiTFL repair, and screw fixation (ART group), or conventional closed reduction of the syndesmosis followed by screw fixation (CR group). The primary outcome measure was anteroposterior (AP) displacement of the fibula on CT scan at 3 months postoperatively. Secondary outcome measures included the Maryland Foot Score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, and the Foot and Ankle Outcome Score (FAOS).Results:Mean AP difference between injured and noninjured ankles was decreased in the ART group compared with the CR group (0.7 ± 0.3 mm vs 1.5 ± 0.3 mm, P = .008). No differences were observed between groups in overall scores for secondary outcome measures. The ART group displayed a significant difference in Maryland Foot Shoe subscore at 12 months (ART = 9.5 vs CR = 8.3, P = .03) and FAOS Quality of Life subscore at 12 months (64.1 compared to 38.3, P = .04).Conclusion:Open anatomic syndesmotic repair resulted in improved radiographic outcomes compared with closed reduction. Cosmesis was worse at 6 weeks compared to the CR group; however, quality of life and shoewear were improved in the ART group at 1 year postoperatively.Level of Evidence:Level II, prospective comparative study.

Clinical study of circulating tumor cells in monitoring the efficacy of neoadjuvant immunotherapy for non-small cell lung cancer

Objective: To investigate the changes of CTCs and the correlation between the changes of CTCs and the clinical efficacy of neoadjuvant immunotherapy for non-small cell lung cancer (NSCLC). Methods: A retrospective case-control study was conducted to collect the data of 23 patients with NSCLC who received neoadjuvant immunotherapy in the Third Xiangya Hospital from June 2018 to December 2019. They were 35-76 years old with a median age of 52 years old, including 13 male patients and 10 female patients. The CTCs value, evaluation results from response evaluation criteria in solid tumor (RECIST) and major pathological response were evaluated before treatment, after neoadjuvant immunotherapy and after operation. Mann Whitney U test was used for the comparison between the two groups, Wilcoxon test was used for the comparison of association samples, and Kruskal Wallis test was used for the comparison between multiple samples. Results: The CTCs value was positively correlated with tumor progression, that the CTCs value of ⅡB group, ⅢA group and ⅢB group was 10.69 (3.87) FU/3 ml, 12.90 (2.24) FU/3 ml and 16.04 (3.43) FU/3 ml, and the difference was statistically significant (χ2=7.829, P=0.020). Then CTCs decreased to 7.60(4.79) FU/3 ml significantly (Z=4.197,P=0.000), and decreased to 6.22(2.80) FU/3 ml significantly again after surgery(Z=-2.950,P=0.005). In RECIST results, the CTCs value of CR group, PR group and SD group was 12.90(3.79)FU/3 ml, 12.52(3.96) FU/3 ml and 13.58(5.11) FU/3 ml,and no significant difference before treatment (χ²=1.806, P=0.405). After neoadjuvant immunotherapy, the CTCs of CR group decreased to 6.22(3.87) FU/3 ml significantly (Z=-4.950, P= 0.000), and also PR group to7.32(4.31) FU/3 ml (Z=-3.180, P=0.001) or SD group to (Z=-2.023, P=0.043). There was no significant difference between CR group and PR group (Z=-0.838, P=0.402), but significant difference between SD group and CR/PR group (Z=-1.922, P=0.050). After operation, the CTCs of CR, PR and SD group decreased to 6.09(3.43) FU/3 ml, 6.40(1.82) FU/3 ml and 9.20(5.16) FU/3 ml,and there was no significant difference to preparation in CR group and PR group, but significant difference in SD group (Z=-2.023, P=0.043). There was no significant difference between CR group and PR group (Z=-1.134, P=0.257), but significant difference between SD group and CR/PR group (Z=-1.624, P=0.014). Before treatment,CTCs of MPR group and non-MPR group were 11.98(4.14) FU/3 ml and 13.54(4.76) FU/3 ml,and there was no significant difference between them (Z=-1.354, P=0.176). After neoadjuvant immunotherapy, the CTCs of MPR group decreased to 6.36(2.65) FU/3 ml significantly (Z=-2.934, P=0.001) and also in non-MPR group to 10.88(2.80) FU/3 ml (Z=-2.840, P=0.003); but there was significant difference between MPR group and non-MPR group (Z=-3.693, P=0.000), and also the change of CTCs between two groups (Z=-2.770, P=0.006). After operation, the CTCs of MPR group decreased to 5.40(1.33) FU/3 ml insignificantly (Z=-0.533, P=0.594) but significantly to 7.05(3.80) FU/3 ml in non-MPR group (Z=-2.734, P=0.030), and significant difference between them (Z=-1.900, P=0.011). Conclusion: The value of CTCs is negatively correlated with the efficacy (RECIST and MPR) of neoadjuvant immunotherapy for NSCLC, which can be used for clinical efficacy evaluation of neoadjuvant immunotherapy.

The polymict carbonaceous breccia Aguas Zarcas: A potential analog to samples being returned by the OSIRIS‐REx and Hayabusa2 missions

AbstractOn April 23, 2019, a meteorite fall occurred in Aguas Zarcas, Costa Rica. According to the Meteoritical Bulletin, Aguas Zarcas is a brecciated CM2 chondrite dominated by two lithologies. Our X‐ray computed tomography (XCT) results show many different lithologies. In this paper, we describe the petrographic and mineralogical investigation of five different lithologies of the Aguas Zarcas meteorite. The bulk oxygen isotope compositions of some lithologies were also measured. The Aguas Zarcas meteorite is a breccia at all scales. From two small fragments, we have noted five main lithologies, including (1) Met‐1: a metal‐rich lithology; (2) Met‐2: a second metal‐rich lithology which is distinct from Met‐1; (3) a brecciated CM lithology with clasts of different petrologic subtypes; (4) a C1/2 lithology; and (5) a C1 lithology. The Met‐1 lithology is a new and unique carbonaceous chondrite which bears similarities to CR and CM chondrite groups, but is distinct from both based on oxygen isotope data. Met‐2 also represents a new type of carbonaceous chondrite, but it is more similar to the CM chondrite group, albeit with a very high abundance of metal. We have noted some similarities between the Met‐1 and Met‐2 lithologies and will explore possible genetic relationships. We have also identified a brecciated CM lithology with two primary components: a chondrule‐poor lithology and a chondrule‐rich lithology showing different petrologic subtypes. The other two lithologies, C1 and C1/2, are very altered and possibly related to the CM chondrite group. In this article, we describe all the lithologies in detail and attempt a classification of each in order to understand the origin and the history of formation of the Aguas Zarcas parent body.

Efficacy and Safety of DWJ1252 Compared With Gasmotin in the Treatment of Functional Dyspepsia: A Multicenter, Randomized, Double-blind, Active-controlled Study.

Background/AimsProkinetics such as mosapride citrate CR (conventional-release; Gasmotin) are commonly used in functional dyspepsia (FD). This study aims to evaluate the efficacy and safety of once-a-day mosapride citrate SR (DWJ1252), a sustained-release formulation of mosapride citrate, compared with mosapride citrate CR 3 times a day, in patients with FD.MethodsIn this multicenter, randomized, double-blind, active-controlled, non-inferiority study, 119 patients with FD (by the Rome III criteria, 60 for mosapride citrate SR and 59 for mosapride citrate CR) were randomly allocated to mosapride citrate SR once daily or mosapride citrate CR thrice daily for 4 weeks in 16 medical institutions. Primary end point was the change in gastrointestinal symptom (GIS) score from baseline, assessed by GIS questionnaires on 5-point Likert scale after 4-week treatment. Secondary end points and safety profiles were also analyzed.ResultsThe study included 51 and 49 subjects in the mosapride citrate SR and mosapride citrate CR groups, respectively. GIS scores at week 4 were significantly reduced in both groups (mean ± SD −10.04 ± 4.45 and −10.86 ± 5.53 in the mosapride citrate SR and mosapride citrate CR groups, respectively; P < 0.001), and the GIS changes from baseline did not differ between the 2 groups (difference, 0.82 point; 95% CI, −1.17, 2.81; P = 0.643). Changes in GIS at weeks 2 and 4 and quality of life at week 4, and the improvement rates of global assessments at weeks 2 and 4, did not differ between the groups. Adverse events were similar in the 2 groups, and there were no serious adverse events.ConclusionIn patients with FD, mosapride citrate SR once daily is as effective as mosapride citrate CR thrice daily, with a similar safety profile.

Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients

The burden of injury and costs of wrist fractures are substantial. Surgical treatment became popular without strong supporting evidence. To assess whether current surgical treatment for displaced distal radius fractures provided better patient-reported wrist pain and function than nonsurgical treatment in patients 60 years and older. In this multicenter randomized clinical trial and parallel observational study, 300 eligible patients were screened from 19 centers in Australia and New Zealand from December 1, 2016, until December 31, 2018. A total of 166 participants were randomized to surgical or nonsurgical treatment and followed up at 3 and 12 months by blinded assessors. Those 134 individuals who declined randomization were included in a parallel observational cohort with the same treatment options and follow-up. The primary analysis was intention to treat; sensitivity analyses included as-treated and per-protocol analyses. Surgical treatment was open reduction and internal fixation using a volar-locking plate (VLP). Nonsurgical treatment was closed reduction and cast immobilization (CR). The primary outcome was the Patient-Rated Wrist Evaluation score at 12 months. Secondary outcomes were Disabilities of Arm, Shoulder, and Hand questionnaire score, health-related quality of life, pain, major complications, patient-reported treatment success, bother with appearance, and therapy use. In the 300 study participants (mean [SD] age, 71.2 [7.5] years; 269 [90%] female; 166 [81 VLP and 85 CR] in the randomized clinical trial sample and 134 [32 VLP and 102 CR] in the observational sample), no clinically important between-group difference in 12-month Patient-Rated Wrist Evaluation scores (mean [SD] score of 19.8 [21.1] for VLP and 21.5 [24.3] for CR; mean difference, 1.7 points; 95% CI -5.4 to 8.8) was observed. No clinically important differences were found in quality of life, wrist pain, or bother at 3 and 12 months. No significant difference was found in total complications between groups (12 of 84 [14%] for the CR group vs 6 of 80 [8%] for the VLP group; risk ratio [RR], 0.53; 95% CI, 0.21-1.33). Patient-reported treatment success favored the VLP group at 12 months (very successful or successful: 70 [89%] vs 57 [70%]; RR, 1.26; 95% CI, 1.07-1.48; P = .005). There was greater use of postoperative physical therapy in the VLP group (56 [72%] vs 44 [54%]; RR, 1.32; 95% CI, 1.04-1.69; P = 0.02). This randomized clinical trial found no between-group differences in improvement in wrist pain or function at 12 months from VLP fixation over CR for displaced distal radius fractures in older people. http://anzctr.org.au identifier: ACTRN12616000969460.

Methylation of PAX1 gene promoter in the prediction of concurrent chemo-radiotherapy efficacy in cervical cancer.

Objectives: Cervical cancer is the fourth leading cause of cancer death among women worldwide. In currently, aberrant methylation of PAX1 is found in variety of solid tumors, including cervical cancer. In addition, the role of PAX1 gene methylation in cervical cancer and precancerous lesions screening has been confirmed in previous study. Here, we evaluated the predictive value of PAX1 methylation in concurrent chemo-radiotherapy (CCRT) outcomes in cervical cancer.Methods: This study enrolled 82 cervical cancer patients from August 2018 to August 2020. We compared the clinical results between different PAX1 methylation status. Hyper-methylation patients were subjects to MRI and quantitative methylation-specific PCR (QMSP) for PAX1 before, in the middle, immediately after, 1 month and 3 months after CCRT. The changes in PAX1 methylation during CCRT were analyzed.Results: The lower PAX1 methylation status were related to a poor tumor response. Based on the MRI findings three months post-treatment, the hypermethylated patients were classified into the complete response (CR; n=50) and partial remission (PR; n=18) groups. The average PAX1 △Cp value of CR and PR groups before radiotherapy was 5.08±1.98 and 4.32±2.00 respectively, and after concurrent chemo-radiotherapy was significantly increased to 17.35±4.96 and 16.99±6.17, respectively (P<0.05). Furthermore, the PAX1 △Cp value between CR and PR groups were significantly different at mid-treatment and performed well in predicting short-term efficacy (AUC 0.84) in this period, and its sensitivity and specificity for predicting PR were 0.72 and 0.88, respectively.Conclusion: The PAX1 methylation level may predict the sensitivity and efficacy of CCRT in cervical cancer.

Effect of Rāja yoga Meditation on Psychological and Functional Outcomes in Spinal Cord Injury Patients.

Background:Spinal cord injury (SCI) is a debilitating disorder with dysfunction in daily activities and psychological consequences like anxiety as well as depression impacting the quality of life substantially. Existing treatments focus mainly on rehabilitation, symptom reduction, and secondary complications. However, psychological, social, and existential issues are least addressed in the prevailing models.Aims:To study the role of meditation in addressing psychological impairment and any resultant improvement in functional outcomes in SCI patients.Methods:Nonrandomized controlled study was conducted in a tertiary care center for SCI patients. Hospital inpatients were recruited into either experimental intervention group (add on easy rāja yoga with conventional rehabilitation-ER n = 50) or control intervention group (conventional rehabilitation alone-CR n = 50). Patients in the ER group received easy rāja yoga for 1 month, along with conventional rehabilitation and the CR group patients received only conventional rehabilitation. All the subjects were assessed for psychological (perceived stress scale [PSS], Hospital Anxiety and Depression Scale [HADS]) and functional impairment (spinal cord independence measure (SCIM), numeric pain rating (NPR) and WHO quality of life-BRIEF (WHOQOLBREF)] at baseline and after 1 month.Results:After 1 month of add-on easy rāja yoga, there was significant decrease in the scores of HADS (F[1,88] = 272.92, P < 0.001), PSS (F[1,88] = 274.41, P < 0.001) and NPR (F[1,88] = 60.60, P < 0.001) and significant increase in the scores of WHOQOLBREF (F[1,88] = 349.94, P < 0.001) and SCIM (F[1,88] = 29.09, P < 0.001) in the ER group compared to CR group in analysis of covariance.Conclusion:One-month add-on easy rāja yoga improves psychological and functional outcomes (HADS, PSS, NPR, WHOQOLBREF and SCIM) in patients with SCI. Future studies with robust designs are needed to validate the results.

Core level shifts as indicators of Cr chemistry on hydroxylated α-Al2O3(0001): a combined photoemission and first-principles study.

The Cr/α-Al2O3(0001) interface has been explored by X-ray photoemission spectroscopy, X-ray absorption spectroscopy (XAS) and ab initio first-principles calculations of core level shifts including final state effects. After an initial oxidation via a reaction with residual surface OH but no reduction of the alumina substrate, Cr grows in a metallic form without any chemical effect on the initially oxidized Cr. However, Cr metal lacks crystallinity. Long-range (reflection high energy electron diffraction) and short-range (XAS) order are hardly observed. Thus photoemission combined with atomistic simulations becomes a unique tool to explore the chemistry and environment at the Cr/alumina interface. Cr 2p, O 1s and Al 2s shifted components are all explained by the formation of moieties involving Cr3+ and/or Cr4+ and of metallic Cr0, which supports the previously found Cr buffer mechanism for poorly adhesive metals. Beyond the situation under study, the present data demonstrate the ability of a combined experimental and theoretical approach of core-level shifts to exhaustively describe the general case of disordered metal/oxide interfaces.